38 THE NOSE AND PARANASAL SINUSES
PROGNOSIS. There is no known cure for this condition, although spontaneous
cure is on record.
TREATMENT. This consists in the main in cleanliness. In the first place the
nostrils are plugged with tampons of cotton-wool inserted as tightly as
possible, and allowed to remain for half an hour. Many crusts may come
away when the wool is removed. The nose is then douched with a solution of
normal saline, or sodium bicarbonate (1-3 per cent), or boric solution (1-60),
using a pint (0-51) of fluid for each side. After the nose has thus been
thoroughly cleared of crusts the nasal mucosa should be sprayed with a
solution of 1 per cent stilboestrol in oil. This regime is used twice daily to
begin with, and later reduced to once daily for the rest of the life of the
Operations to reduce the width of the nasal cavities have been devised.
Some sought to narrow the cavities by submucous implantations into the
inferior concha or by the submucous injection of Teflon paste. A recent
operation consists of raising folds of skin inside the nostrils and suturing
them together to close the nasal cavities completely. It is said that such a
complete closure over a period of years can lead to the regeneration of
ciliated epithelium, and that when the nostrils are reopened after several
years the ciliated epithelium does not revert to the squamous type.
This is not generally recognized as a clinical entity, but the term is used to
denote a condition which is met with in patients who work in hot, dry, dusty
surroundings, such as rubber-workers, furnacemen, bakers, etc. It may also
be found in those addicted to tobacco, and may be found postoperatively as a
lesser stage of atrophic rhinitis.
SYMPTOMS. The patient complains of dryness in the nose, the expulsion of
thin crusts, and occasional epistaxis.
CLINICAL FEATURES. The nasal mucosa is dark red and congested and there
may be sticky secretion and small adherent crusts. The septum may be
excoriated with picking, and may even be perforated.
TREATMENT. If crusting is marked, douching of the nose will remove the
crusts and sticky secretion. If not, the daily application of petroleum jelly or
an ointment containing an antibiotic and hydrocortisone (Terca-CortrH or
Soframycin) should prevent the crust formation. Smoking should be reduced